Provider Demographics
NPI:1134361397
Name:SHENGAOUT, JULIA (LAC)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:SHENGAOUT
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:415 SABLE CT
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:GA
Mailing Address - Zip Code:30004-8013
Mailing Address - Country:US
Mailing Address - Phone:404-849-8805
Mailing Address - Fax:678-393-2947
Practice Address - Street 1:13680 HIGHWAY 9 N STE F-300
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-5182
Practice Address - Country:US
Practice Address - Phone:404-849-8005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA228171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist